Small gauge surgical instrument with support device

ABSTRACT

A small gauge surgical instrument assembly is shown with advantages such as diminished “play” at the tip. A surgical instrument assembly is also shown with support along a length of the instrument that can be selected by the surgeon. In particular, very small and flexible instruments for vitreous surgery are shown with selectable stiffness, thus providing control as well as access to all parts of the vitreous cavity. Embodiments as shown are safer, and increase the variety of cases for which these instruments can be used.

RELATED APPLICATION

This application is a divisional application of U.S. application Ser.No. 10/844,592, filed May 12, 2004, which application is acontinuation-in-part and claims priority of invention under 35 U.S.C.§120 from U.S. application Ser. No. 10/767,556, filed Jan. 29, 2004,which claims the benefit of U.S. Provisional Application Ser. No.60/443, 375, filed on Jan. 29, 2003, under 35 U.S.C. 119(e), thespecifications of which are incorporated herein by reference in theirentirety.

TECHNICAL FIELD

This invention relates to small gauge instruments typically used forsurgical procedures such as surgery of the eye. Specifically, thisinvention relates to small gauge surgical instruments for use invitreous surgery.

BACKGROUND

Vitreous surgery was first performed in 1971, and involves the removalof the vitreous gel from the posterior aspect of the eye for treatmentof a variety of disease states, including vitreous hemorrhage, maculardisorders, retinal detachment, and many others. One common procedureinvolves the use of 3 incisions peripheral to the cornea to access thevitreous cavity. One port is used for infusion, one for illumination,and the third for suction/cutting instruments, as well as picks,scissors, forceps and others.

As the surgical approaches have evolved, smaller incisions are beingused. The most common incision size currently is 20 gauge (1.0 mmdiameter), but newer instruments as small as 25 gauge (0.49 mm diameter)are being introduced, and smaller instruments are likely in the future.The advantages of smaller incisions are multiple, including lessenedtrauma, faster healing, faster wound management (no sutures), andgreater patient comfort.

Problems exist with the smaller instruments, however. The small diameterof the instruments makes them quite flexible, which is a disadvantagefor the surgeon. With larger diameter instruments, there is very little“play”, so the tips of the instruments go exactly where the surgeondesires that they go. With the smaller diameter instruments, the tipscan move from their intended positions due to the bending or flexing ofthe fine wire-like instruments, which makes the surgeon feel a loss ofcontrol.

Bending or flexing of the small instruments is of particular concernduring removal of peripheral vitreous, when the eye must be turned toallow viewing by the surgeon. Turning of the eye is accomplished bymoving the instrument relative to the patient's head while a portion ofthe instrument remains inserted within a portion of the eye. Because theamount of flexing of the instrument is relatively large andunpredictable to the surgeon, precise repositioning of the eye becomesmore difficult.

What is needed is an instrument design that accommodates increasinglysmall diameters, and still provides precise control without unwantedflexing.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a surgical instrument according to an embodiment of theinvention.

FIG. 2 shows a variation of a surgical instrument according to anembodiment of the invention.

FIG. 3 shows another variation of a surgical instrument according to anembodiment of the invention.

DETAILED DESCRIPTION

In the following detailed description, reference is made to theaccompanying drawings which form a part hereof, and in which is shown,by way of illustration, specific embodiments in which the invention maybe practiced. In the drawings, like numerals describe substantiallysimilar components throughout the several views. These embodiments aredescribed in sufficient detail to enable those skilled in the art topractice the invention. Other embodiments may be utilized andstructural, or logical changes, etc. may be made without departing fromthe scope of the present invention.

FIG. 1 shows an instrument 100 including a small diameter instrumentportion 110, and a support device portion 120. The small diameterinstrument portion 110 includes a distal end 112 and a proximal end 114.In one embodiment, the small diameter instrument portion 110 includes ahollow tube. Other embodiments include, but are not limited to smalldiameter instrument portions such as fiber optic probes, laser guides,suction/cutting tools, forceps, scissors, etc. The small diameterinstrument portion 110 shown in the Figures is drawn without specificdetail of the selected instrument, however, one of ordinary skill in theart, having the benefit of the present disclosure will recognize thatseveral small diameter instruments are possible. The small diameterinstrument portion 110 and the support device portion 120 are adjustablerelative to each other, allowing the surgeon to selectively providesupport at different locations along a length of the small diameterinstrument portion 110.

In one embodiment, a support device portion 120 of adequate stiffness ispositioned along the shaft of the small diameter instrument portion 110(25 gauge or the like). The support device portion 120 stabilizes theinstrument so the surgeon using it has a greater sense of securityregarding the position of the tip inside the eye. The support deviceportion 120 is adjustable so that the full length of the small diameterinstrument portion 110 can be selectively inserted into the eye forposterior work. Posterior work typically requires minimal twistingmotion by the surgeon, therefore a lower need for stabilization.Although a 25 gauge device is used as an example, the invention is notso limited. One of ordinary skill in the art, having the benefit of thepresent disclosure will recognize that any instrument of a smaller orlarger diameter than a 25 gauge instrument will benefit from increasedsupport depending on the forces and tolerances within a given procedure.

For peripheral vitrectomy the support device portion 120 could be moveddown the shaft of the small diameter instrument portion 110 to provideincreased support. With the support device portion 120 moved closer tothe distal end 112, less play would be present at the distal end 112 ofthe small diameter instrument portion 110 when the eye is twisted andturned by the surgeon.

In one embodiment, the support device portion 120 design includes a 20gauge cylinder 124 of a strong material such as stainless steel, to goaround the small diameter instrument portion 110 (25 gauge or so). Thecylinder 124 is attached to a strong shaft 122 that runs parallel to thesmall diameter instrument portion 110, and sits in a track 132 embeddedin a handpiece 130. Although a single shaft 122 is shown, multiple shaft122 embodiments are also within the scope of the invention. Thehandpiece 130 is directly attached to the small diameter instrumentportion 110. The shaft 122 is of such a length that an amount of travelalong the small diameter instrument portion 110 is available (forexample, 10-15 mm). The amount of travel is selectable by the surgeon. Aknob or other control device 126 is attached to the shaft 122, and theposition of the cylinder 124 (i.e. how far down the shaft of the fineinstrument it rests) is controlled by the surgeon.

In one embodiment, a number of stops lock the strut 122 in position atpreset lengths, giving the surgeon varying levels of control over theflex of the small diameter instrument portion 110, while concurrentlyallowing the small diameter instrument portion 110 to enter the eye tovarious lengths, depending on the strut position. In one embodiment aclutch or set screw locks the strut 122 in position relative to thesmall diameter instrument portion 110.

FIG. 2 shows another embodiment of an instrument 200. In FIG. 2, a fineinstrument portion 210 is the adjustable portion relative to thehandpiece 230, and the support device portion 220 is fixed relative tothe handpiece 230. In one embodiment, the fine instrument portion 210 ismade to move within a 20 gauge or similar cylinder. Similar toembodiments described above, the fine instrument portion 210, inselected embodiments is controlled with a knob, or other control 214within a channel 232, moved as desired by the surgeon.

FIG. 3 shows an instrument assembly 300. In one embodiment, a fineinstrument portion 310 is coupled to a fine instrument base unit 330. Inone embodiment, the base unit 330 includes a handpiece as described inembodiments above. In one embodiment, the base unit 330 and fineinstrument portion 310 include existing configurations of surgicalinstruments such as cannulas, probes, fiber optic devices, laser guides,suction/cutting tools, forceps, scissors, etc. A distal end 312 of thefine instrument portion 310 is shown in FIG. 3 as a cutting tool orhypodermic tip example although the invention is not so limited. Asupport device 320 is shown in FIG. 3 as a component of the instrumentassembly 300. In one embodiment, the support device 320 includes a base324 and an extending portion 322.

In one embodiment, the extending portion 322 includes a tube with aninner diameter that closely matches an outer diameter of the fineinstrument portion 310. Although a continuous tube is shown as theextending portion 322 in FIG. 3, the invention is not so limited. Forexample, in an alternate embodiment, a portion of a tube, or otherconnecting structure is coupled to a location along the length of thefine instrument portion 310. In alternate embodiments, the tube portionor other connecting structure is then coupled to the base portion 324through an intermediate support system.

In one embodiment, the instrument assembly 300 includes multiple supportdevices 320 with extending portions 322 of varying lengths. In oneembodiment, the instrument assembly 300 includes multiple supportdevices 320 with extending portions 322 of varying stiffness. Inoperation, one of the support devices 320 with a desired length isselected to provide the desired amount of support to the fine instrumentportion 310. Other support devices 320 with different lengths are laterinterchanged to provide varying amounts of support and/or locations ofsupport in one method of operation. One advantage of the instrumentassembly 300 includes the ability to provide support to existing fineinstrument portion configurations.

CONCLUSION

Thus has been shown, a support device which diminishes the “play” invery small and flexible instruments, such as instruments for vitreoussurgery. Embodiment described above include designs wherecharacteristics such as stiffness can be adjusted by the surgeon.Embodiments described above also include adjustments so access ispossible to all parts of the vitreous cavity. Embodiments as shown aboveprovide features to make surgical procedures safer. Embodimentsdescribed above also increase the variety of cases for which small, moreflexible instruments can be used. Although vitreous surgery is discussedabove as an example procedure, embodiments of the invention describedabove and in the following claims are not so limited. Other surgicalprocedures will also benefit from the advantages that these deviceconfigurations provide.

While a number of advantages of embodiments described herein are listedabove, the list is not exhaustive. Other advantages of embodimentsdescribed above will be apparent to one of ordinary skill in the art,having read the present disclosure. Although specific embodiments havebeen illustrated and described herein, it will be appreciated by thoseof ordinary skill in the art that any arrangement which is calculated toachieve the same purpose may be substituted for the specific embodimentshown. This application is intended to cover any adaptations orvariations of the present invention. It is to be understood that theabove description is intended to be illustrative, and not restrictive.Combinations of the above embodiments, and other embodiments will beapparent to those of skill in the art upon reviewing the abovedescription. The scope of the invention includes any other applicationsin which the above structures and fabrication methods are used. Thescope of the invention should be determined with reference to theappended claims, along with the full scope of equivalents to which suchclaims are entitled.

1. A method, comprising: selecting a support frame coupled to a smalldiameter instrument portion at a location along its length; engaging aportion of an eye using the small diameter instrument portion; impartinga lateral force on the eye using a portion of the small diameterinstrument portion along with additional lateral support provided by thesupport frame.
 2. A method, comprising: coupling a support frame to asmall diameter instrument portion at a location along its length;engaging a portion of an eye using the small diameter instrumentportion; imparting a lateral force on the eye using a portion of thesmall diameter instrument portion along with additional lateral supportprovided by the support frame.
 3. The method of claim 2, furtherincluding removing the support frame from the small diameter instrumentportion after imparting the lateral force on the eye.
 4. The method ofclaim 2, wherein coupling a support frame to a small diameter instrumentportion at a location along its length includes inserting the smalldiameter instrument portion through a portion of a tube with a closetolerance fit to the small diameter instrument portion.
 5. The method ofclaim 2, wherein coupling a support frame to a small diameter instrumentportion at a location along its length includes selecting a tube portionwith a tube length that provides a desired amount of lateral support. 6.The method of claim 2, wherein engaging the portion of the eye includespenetrating a portion of the surface of the eye through an incision. 7.A method, comprising: engaging a portion of an eye using a handheldsubstantially rigid small diameter instrument portion extending from abase unit, the small diameter instrument portion having a diametersmaller than 20 gauge; imparting a lateral force on the eye using aportion of the small diameter instrument portion along with additionallateral support provided by a support sleeve located around an end ofthe instrument portion adjacent to the base unit, and extending from thebase unit, wherein the support sleeve includes a tube with an innerdiameter that closely matches an outer diameter of the small diameterinstrument portion.
 8. The method of claim 7, wherein engaging theportion of the eye includes engaging a portion of an eye using ahandheld substantially rigid 25 gauge instrument portion.
 9. The methodof claim 7, wherein imparting the lateral force on the eye includesimparting a lateral force on the eye using a portion of the smalldiameter instrument portion along with additional lateral supportprovided by a stainless steel tube.
 10. A method, comprising: engaging aportion of an eye using a handheld substantially rigid small diameterinstrument portion extending from a base unit, having a diameter smallerthan 20 gauge; imparting a lateral force on the eye using a portion ofthe small diameter instrument portion along with additional lateralsupport provided by a support frame coupled to an end of the instrumentportion adjacent to the base unit, and extending from the base unit. 11.The method of claim 10, wherein engaging the portion of an eye includesengaging a portion of an eye using a handheld substantially rigid smalldiameter instrument portion chosen from a group consisting of fiberoptic devices, laser guides, suction tools, cutting tools, forceps, andscissors.
 12. The method of claim 10, further including selecting aposition of the support frame along a length of the small diameterinstrument portion to provide a selected amount of support.
 13. Themethod of claim 10, wherein imparting the lateral force on the eyeincludes imparting a lateral force on the eye using a portion of thesmall diameter instrument portion along with additional lateral supportprovided by a support sleeve located around an end of the small diameterinstrument portion wherein the support sleeve includes a tube with aninner diameter that closely matches an outer diameter of the smalldiameter instrument portion.